腹式与阴式子宫切除术临床疗效比较

目的比较腹式子宫切除术与阴式子宫切除术2种手术方法的临床疗效。方法选择我院2007年1月至2009年12月48例阴式子宫切除术患者（阴式组）,同时随机抽取腹式子宫切除术48例腹式组,对2组患者手术时间、术中出血量、术后排气时间、术后切口感染例数、住院时间进行比较。结果阴式组的手术时间、术中出血量、术后排气时间、术后感染例数、术后并发症、术后疼痛评分、住院时间都明显少于腹式组.差异具有统计学意义（P〈0.01）。结论阴式子宫切除术具有对患者损伤小、腹部无瘢痕、术后恢复快,并发症少、住院时间短等优点。     

Does increased nuchal translucency indicate a fetal abnormality? A retrospective study to clarify the clinical significance of nuchal translucency in Japan

The results of a chromosomal test by genetic amniocentesis in 58 cases with an increased nuchal translucency (NT; > or =3 mm thickness) revealed 47 cases showing a normal karyotype (81%) and 11 cases (19%) showing an abnormal karyotype. However, the cases of a normal karyotype with increased NT also included those with fetal abnormalities. Among the 49 cases in which NT was observed during the first trimester and then subsequently disappeared, chromosomal abnormalities were observed in five, and fetal abnormalities other than chromosomal abnormalities were observed in two. Meanwhile, all nine cases in which an increased NT remained or in which NT continued to increase in size during the second trimester were diagnosed as having cystic hygroma, and chromosomal abnormalities were found in six cases (67%). It should be noted that the shape of increased NT includes NT with a notch (notched NT) and NT without a notch (smooth NT). Among the 20 cases of notched NT, chromosomal abnormalities were observed in eight (40%), and cystic hygroma was observed in nine (45%). On the other hand, among the 38 cases of smooth NT, chromosomal abnormalities were observed in three (7.9%), but no cystic hygroma was observed. Our results confirm that increased NT does not always indicate a fetal abnormality. Whether NT thickness should be measured as a screening tool for fetal abnormalities remains controversial. However, increased NT may be detected by chance, because a maternal-fetal medical examination using ultrasonography is usually performed in Japan. It is therefore considered to be extremely important to establish a system in which cases are referred to obstetricians who are licensed clinical genetic specialists to obtain appropriate genetic counseling whenever increased NT is clinically observed.     

The role of low molecular weight heparin on recurrent pregnancy loss: A systematic review and meta-analysis

To assess the roles of the low molecular weight heparin (LMWH) on recurrent pregnancy loss (RPL). The relevant studies of all randomized controlled trials (RCTs) were retrieved, and the systematic evaluation was conducted. PubMed, Embase, and Cochrane library databases were searched by using keywords, including low-molecular-weight heparin or LMWH, and recurrent miscarriage or recurrent pregnancy loss in pregnant women from their earliest data to February 2020. Two investigators independently evaluated eligibility. Risk ratios (RRs) and their corresponding 95% confidence interval (CI) were determined. To pool the results, this meta-analysis was performed using random-effect model due to the high heterogeneity among these eight studies. A total of eight RCTs involving 1854 participants were included in the meta-analysis involving 963 patients with RPL who were prescribed LMWH (enoxaparin, tinzaparin, or dalteparin) alone and 891 patients who were treated with no LMWH interventions (placebo, folic acid or non-treatment) were compared. Pooled data from the remaining eight RCTs showed the differences between intervention groups and control groups. Compared with control groups, LMWH had significantly improved live births (RR,1.19; 95%CI, 1.03 to 1.38; P = 0.02), and reduced miscarriage rates (RR, 0.62; 95%CI, 0.43 to 0.91; P = 0.01). The study suggested that LMWH could improve the live births and reduce the miscarriage rates of RPL. Therefore, LMWH might be a good treatment choice for women with unexplained PRL.     

Pregnancy Outcomes in 2 Women Born with Complex Anorectal Malformations: Challenges and Considerations

BackgroundComplex anorectal malformations (ARMs) are a group of rare congenital malformations involving numerous anomalies that require reconstruction and can affect sexuality, fertility, and pregnancy outcomes. Few cases of pregnancy in complex ARM patients have been reported.CasesWe report on 2 patients with ARMs who delivered 3 term infants, all by cesarean section with successful collaboration between pediatric urologists and obstetricians. Both patients fully recovered with no long-term consequences after experiencing maternal morbidities including urinary infections, clitoral abscesses, vaginal lacerations, extensive adhesive disease, bladder injury, and maternal hemorrhage.Summary and ConclusionIn managing pregnancies and deliveries in women with complex ARMs, coordination between obstetricians, pediatric urologists, and pediatric surgeons is crucial.     

Optimal treatment of hypothyroidism associated with live birth in cases of previous recurrent placental abruption and stillbirth

Objective

To examine the clinical management of and placentas from pregnant women with hypothyroidism and obstetric history of recurrent stillbirth in order to identify possible etiologic mechanisms.

Methods

Two cases involving 26-year-old women with hypothyroidism and history of recurrent stillbirth are reported. Placentas from all of the women’s pregnancies were compared in order to identify histologic similarities.

Results

In both cases, multifocal hemorrhagic infarctions and abruptions were seen, indicating progressive uteroplacental ischemic damage leading to stillbirth. Thrombophilia, infection, and diabetes tests were all negative. With meticulous monitoring and normalization of thyroid function by end of first/early second trimester in subsequent pregnancies, there were live births and no evidence of infarction on placental histology.

Conclusion

The 2 reported cases raise the possibility of uteroplacental ischemia and placental abruption being mechanisms by which hypothyroidism can lead to stillbirth; they also highlight the potential of minimizing this risk via adequate levothyroxine treatment from early pregnancy.     

Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes

Objective: To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock. Methods: We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher’s Exact and Mann–Whitney U tests. Results: Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin >4?mg/dl (p = 0.04), failure in ≥3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function. Conclusions: ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery.     

不同时机硬膜外分娩镇痛对产程及母婴的影响

目的研究不同时机行硬膜外自控分娩镇痛对产程及母婴的影响。方法选择头胎的足月初产妇200例,随机均分为Ⅰ、Ⅱ、Ⅲ组和对照组(Ⅳ组)。Ⅰ组在宫口开至3~5 cm时行分娩镇痛,Ⅱ、Ⅲ组在宫口开至1 cm时行分娩镇痛,Ⅰ、Ⅱ组宫口开全停止镇痛,Ⅲ组宫口开至8 cm时停止镇痛。Ⅳ组为对照组,按产科常规处理。观察并记录各产程持续时间;记录宫口开至1 cm(T0)、3cm(T1)、8 cm(T2)、宫口开全时(T3)、胎儿娩出时(T4)的镇痛评分(VAS评分);记录分娩方式、缩宫素的使用情况;记录新生儿1、5 min Apgar评分、脐动脉血血气分析及新生儿神经行为(NBNA)1~3d的评分。结果第一产程潜伏期Ⅱ、Ⅲ组明显短于Ⅰ、Ⅳ组(P<0.01),活跃期Ⅰ、Ⅱ、Ⅲ组短于Ⅳ组(P<0.05),第二产程时间Ⅲ组短于Ⅰ、Ⅱ组(P<0.05);Ⅱ、Ⅲ组产妇的VAS评分明显低于Ⅳ组(P<0.05);Ⅲ、Ⅳ组产钳助产率明显低于Ⅰ、Ⅱ组(P<0.05);四组新生儿1、5 min Apgar评分、脐动脉血血气分析的各项指标差异均无统计学意义;新生儿出生后第1天NBNA评分(NBNA1评分)Ⅲ组明显高于Ⅰ、Ⅱ、Ⅳ组(P<0.05)。结论...     

General anesthesia for cesarean delivery at a tertiary care hospital from 2000 to 2005: a retrospective analysis and 10-year update

Background

Complications from general anesthesia for cesarean delivery are a leading cause of anesthesia-related mortality. As a consequence, the overall use of general anesthesia in this setting is becoming less common. The impact and implications of this trend are considered in relation to a similar study performed at our institution 10 years ago.

Methods

The hospital database for all cesarean deliveries performed during six calendar years (January 1, 2000 through December 31, 2005) was reviewed. The medical records of all parturients who received general anesthesia were examined to collect personal details and data pertinent to the indications for cesarean delivery and general anesthesia, mode of airway management and associated anesthetic complications.

Results

Cesarean deliveries accounted for 23.65% to 31.51% of an annual total ranging from 8543 to 10091 deliveries. The percentage of cases performed under general anesthesia ranged from 0.5% to 1%. A perceived lack of time for neuraxial anesthesia accounted for more than half of the general anesthesia cases each year, with maternal factors accounting for 11.1% to 42.9%. Failures of neuraxial techniques accounted for less than 4% of the general anesthesia cases. There was only one case of difficult intubation and no anesthesia-related mortality was recorded.

Conclusion

The use of general anesthesia for cesarean delivery is low and declining. These trends may reflect the early and increasing use of neuraxial techniques, particularly in parturients with co-existing morbidities. A significant reduction in exposure of trainees to obstetric general anesthesia has been observed.